dding to the debate over using
antidepressant drugs for depressed teenagers and children, a group
of prominent researchers issued a report yesterday saying that
Zoloft and similar medicines did not increase children's suicide
The group, drawn from members of the American College of Neuro-
psychopharmacology, also found that the drugs were effective in
treating children's depression.
"Depression in children and adults is the major illness that
underlies suicide, and we believe that the S.S.R.I. class represents
the medication with the greatest efficacy against this very serious
condition," said Dr. J. John Mann, a professor of psychiatry at
Columbia University who was co-chairman of the reporting panel.
Those conclusions are hotly contested, and the report does not
settle the debate on giving children the medicines, selective
serotonin reuptake inhibitors, or S.S.R.I.'s.
Citing associations between antidepressants and suicidal thoughts
or tendencies in children, British drug regulators told doctors last
month not to prescribe those drugs for children, with the exception
The Food and Drug Administration plans hearings on the question
on Feb. 2.
In the new report, the panel reviewed 15 clinical trials, some
unpublished, that included more than 2,000 teenagers and children as
subjects. The trials used varying methods and had disparate
outcomes, but showed that S.S.R.I.'s ó Effexor, Paxil, Prozac,
Zoloft and others ó "are effective in treating depression in
children and adolescents," the report said. It recommended that
clinicians continue to use the drugs for depressed youths, although
it said clinicians should "ask depressed patients about suicide,
suicidal thinking and plans for suicide."
Dr. Jeffrey Lieberman, professor of psychiatry at the University
of North Carolina, said he found the report persuasive.
"What the report said is that the risks of not treating patients
with severe depressive illness outweighs the risk of treating them
with S.S.R.I.'s," Dr. Lieberman said.
Dr. Richard Harrington, professor of child and adolescent
psychiatry at the University of Manchester in England, said he was
not sure that drugs were effective for teenagers and children.
"Maybe they work," Dr. Harrington said. "But if so, they don't
work very well. And I'm still troubled by the suicidality."
Critics pointed to weaknesses in the report. The panel did not
have access to some information that British regulators used to come
up with opposite conclusions.
The report did not undertake a sophisticated and difficult
meta-analysis, in which figures from many studies are pooled for
examination. Other researchers are conducting that analysis.
Critics of the medicines noted that 9 of the 10 task force
members had significant financial ties to the pharmaceutical
industry, although such ties are common among prominent researchers.
The panel said no industry money financed the report.
"Of course they concluded that these drugs are safe," said Tom
Woodward, who said he believed the drugs led his daughter, 17, to
commit suicide. "All these guys are tied to the pharmaceutical
Worries that they might cause a small number of patients to
become intensely suicidal have swirled about the drugs since shortly
after Prozac was introduced. The question seemed to have been put to
rest in 1991, after a Food and Drug Administration panel said there
was no convincing evidence to link the drugs to increased suicide
Millions of people have taken the medicines. Although sporadic
complaints continued to link drugs to suicides, those reports were
widely dismissed as anecdotal, isolated events that could not be
relied on to assess the medicines. But later studies raised new